MEDICARE: JOHN ESTIME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083S0010X	Sports Medicine (Preventive Medicine) Physician	292373	FL

General Provider Information

NPI Number	:	1144072083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ESTIME

Provider Business Mailing Address
First Line	:	1260 NORTHLAKE BLVD
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2050
Country	:	US
Telephone Number	:	913-777-6269
Fax Number	:

Provider Business Practice Location Address
First Line	:	12255 AVENIR DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2599
Country	:	US
Telephone Number	:	305-461-2440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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Directions to “ JOHN ESTIME ” Practice Location

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